Why are doctors still prescribing, and some women still taking, synthetic horse estrogens and progestins?
Drug companies have manipulated the language used in the research and media so that conjugated, synthetic equine estrogens (CEEs) are simply called “estrogen,” which everyone identifies as the primary female hormone. Obviously, this is a highly misleading oversimplification manipulating the fact that the “estrogen class” is composed of a number of hormones that share a similar molecular structure. These hormones, which include the versions of estriol, estradiol, estrone that are found in humans, and different versions of these same hormones, along with equilinin, which are found in horses, have all been lumped under the general term, “estrogens,” as if they were all the same. Emphatically, they are not – as the WHI study results clearly showed!1 2
Very unfortunately for the female patients of uninformed doctors, the pharmaceutical industry actively continues to try to convince physicians, and the public, that synthetic HRT and natural BHRT (which they cannot patent since the hormones used are natural, not new-to-nature compounds) share the same risks. Nothing could be further from the truth! Bio-identical-to-human hormones have significantly different molecular structures than patented, synthetic, alien-to-the-human body horse estrogens and pseudo “progesterone” hormone analogues, and the human body responds to them in very different ways.
For this reason, doctors are told to prescribe conventional HRT, “at the lowest effective dose for the shortest duration possible.” For women who have not had a hysterectomy, synthetic HRT is prescribed cyclically : conjugated equine estrogen (CEE) alone for 15 days, then CEE plus a progestin for 10 days, then nothing for 5 days each month during which menstrual bleeding occurs six or more days after starting the progestin . The alternative method is to take the CEE and progestin every day. On this regimen, women do not usually have regular menstrual periods but often have irregular, light spotting.3
How are bio-identical hormones prescribed?
First, you will be tested to determine what your current hormone levels are. The “gold standard” is a 24-Hour Urine hormone assay. Yes, you get to collect your urine for a full 24-hours to provide the samples required. Everything you need is provided.
This test will give your doctor way more information than the snapshot a blood or saliva test provides. Not only does the 24-Hour Urine avoid the problem of the peaks and valleys of daily hormone levels (in premenopausal women, the ovaries secrete hormones in bursts or pulses throughout the day, so saliva or blood test results can give a misleading picture), but it provides accurate information not only about your levels of active estrogens (estrone, estradiol and estriol), progesterone, testosterone and DHEA, but about whether your hormones are being metabolized into safe or potentially unsafe compounds. Many of these compounds cannot be measured in blood or saliva.
Your doctor will use your test results to prescribe customized doses of the bio-identical hormones you need, which will be made-to-order for you by a compounding pharmacy and delivered via a cream, which is applied to the labia in tiny amounts (about ¼ the size of your pinkie fingernail).
Dosing is cyclical. If your cycle pre-menopause was 28 days, estrogen (typically, Bi-est) will be applied days 1-26 and progesterone days 12-26. If your pre-menopause normal cycle was 26 days or 30 days, your doctor will adapt the dosage schedule to what best suits you. And the doses provided will also be adjusted so that you can get all the benefits of hormone replacement without breakthrough bleeding (spotting) or having a “period” every month.
You will be re-tested every 3 to 6 months until stable, safe levels of all hormones (and hormone metabolites) are achieved, then every 6 months or yearly.
How can you find a doctor knowledgeable about prescribing BHRT?
A number of organizations can help you locate a physician knowledgeable about BHRT. All are listed along with their contact information in Stay Young & Sexy with Bio-Identical Hormone Replacement. These include the American College for Advancement in Medicine, the International College of Integrative Medicine, the American Academy of Environmental Medicine, The Bio-Identical Hormone Society, the American Association for Health Freedom, and Women in Balance.
Stay Young & Sexy with Bio-Identical Hormone Replacement: The Science Explained
This article summarizes key points presented in-depth in almost 500 pages in Stay Young & Sexy with Bio-Identical Hormone Replacement, the Science Explained by Jonathan V. Wright, MD, and. Lane Lenard, PhD. This book is the definitive resource on Bio-identical Hormone Replacement Therapy and fully explains why BHRT is the best option for women, not only to alleviate the discomforts of menopause, but to prevent the long-term negative health consequences of our aging-related decline in sex hormones.
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Heiss G, Wallace R, Anderson GL, et al. Health risks and benefits 3 years after stopping randomized treatment with estrogen and progestin. JAMA. 2008;299:1036-1045.
Crandall C. Low-dose estrogen therapy for menopausal women: a review of safety and efficacy. J Womens Health (Larchmt). 2003;12:723-747.
American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of menopause 2006. Cobin, R. H. et al., Endocrine Practice 2006 May-Jun;12(3):315-337.